The Intersections of Mental Health and Jail

At the start of the year, the Travis County jail reported a significant and startling increase in the number of inmates dealing with mental health issues. According to figures provided by the counseling and education manager at the Travis County Sheriff’s Office, Danny Smith, there were more than 550 persons with mental illness in the Travis County jail in 2015, compared to about 350 in 2006.

As part of Dell Medical School’s vision of creating a vital, inclusive health ecosystem, the Health Disparities team is researching the intersections of mental illness and the criminal justice system in the Travis County community. Our project aims to better understand several key things, including:

The number of people with mental illness in jail

The length of stay for those with mental illness compared to those without mental illness

Patient characteristics and patient demographics of those with a mental illness

The link between mental illness and recidivism

We believe that this type of research inquiry will yield more insight into the behavioral health inequities in our community and, ultimately, will help us craft interventions.

Any discussion of mental health and the criminal justice system is complex. It sheds light on numerous overlapping and entangled factors including illness, health disparity and inequity, crime, socioeconomic status, politics, and the notion of care in society. Recently, the family of Sandra Bland reportedly settled a lawsuit against the Waller County jail and the Texas Department of Public Safety for $1.9 million. While the settlement is still awaiting approval by the Waller County Commissioners Court, Bland’s arrest and death and the subsequent lawsuit bring attention to the intersections of mental illness and criminal justice.

Earlier this year, an outside committee convened in response to Bland’s death conducted an investigation of the Waller County jail and made a list of recommendations, including the need for medical and mental health screening for all inmates, stress management training for deputies, and a ban on demeaning language directed at inmates. In September, Cannon Lambert, the Bland family attorney, told The New York Times that among the conditions of the settlement is a requirement that sensors be used at the jail to ensure that detainee checks are accurately carried out. Lambert also told the newspaper that Waller County Judge Carbett. J. Duhon III had agreed to push for more funding to better the booking and officer training processes at the jail.

In many ways, the conversation surrounding mental health and criminal justice is a difficult one, but the treatment of mentally ill persons in jails and prisons is an issue of health equity — one that is in need of critical attention at this societal juncture, as the recent trends in Travis County reveal. According to the National Alliance on Mental Health (NAMI), about two million people with mental illness are booked into jails each year, and nearly 15 percent of men and 30 percent of women booked into jails have a serious mental illness. Upon release, many of these men and women do not have adequate access to necessary health care. Furthermore, a criminal record makes it harder to obtain housing and employment. A significant percentage of those without access to mental health services and support later find themselves homeless, in emergency rooms, and/or re-arrested. Recent figures suggest that upon release, at least 83 percent of men and women with mental illness do not have access to needed treatment.

NAMI recently announced a partnership with the The Stepping Up Initiative, a national campaign that challenges counties to reduce the number of people with mental illness in jails. The Health Disparities team at Dell Medical School supports this initiative, and believes that our research on mental illness at the Travis County Jail will directly speak to the issues at hand.

In response to the fast-growing numbers of persons with mental illness at the jail, Travis County Judge Sarah Eckhardt is emphasizing collaboration as key to creating solutions. Our team is ready to collaborate and partner with community stakeholders as we focus on developing a model healthy city and county.